Key result
In Chinese emergency department patients with nonvalvular atrial fibrillation, severe renal impairment was associated with a higher risk of all-cause death compared to normal renal function.
Why the study?
Real-world data on the relationship between creatinine clearance and adverse clinical outcomes in Chinese emergency department patients with nonvalvular atrial fibrillation were limited.
Does severe renal impairment (CrCl < 30 ml/min) increase the risk of adverse clinical outcomes in Chinese emergency department patients with nonvalvular atrial fibrillation?
Observational (n=863)
Yes
Does severe renal impairment (CrCl < 30 ml/min) increase the risk of adverse clinical outcomes in Chinese emergency department patients with nonvalvular atrial fibrillation?
In Chinese emergency department patients with nonvalvular atrial fibrillation, severe renal impairment is a strong independent predictor of all-cause and cardiovascular mortality, but not thromboembolism or major bleeding.
Answers are grounded in this paper and cite their sources.
Severe renal impairment flags high mortality in Chinese ED AF; hypothesis-generating and needs prospective validation before guiding care.
Background Few real‐world data on the relation between creatinine clearance (CrCl) and adverse clinical outcomes in Chinese emergency department (ED) patients with nonvalvular atrial fibrillation (AF). Methods In this prospective, observational, multicenter AF study, enrolled AF patients presenting to an ED at 20 hospitals in China from November 2008 to October 2011, with a follow‐up of 12 month. A total of 863 AF patients with CrCl data were analyzed, and patients were categorized as CrCl ≥ 80, 50 ≤ CrCl < 80, 30 ≤ CrCl < 50, and CrCl < 30(ml/min). Outcomes of analyses were all‐cause death, cardiovascular death, thromboembolism (TE), and major bleeding. Results Among the whole patients, 126(14.6%) patients died during 12‐month follow‐up, 53(40.2%) among CrCl < 30 ml/min group, and 48(16.2%), 22(6.5%), and 3(3.2%) among 30 ≤ CrCl50, 50 ≤ Crl < 80, and CrCl ≥ 80 ml/min groups, respectively (p < 0.001). Cardiovascular death and TE rates also increased with decreasing CrCl. On multivariate analysis, patients with CrCl < 30 ml/min were associated with higher risks of all‐cause death (HR 5.567; 95%CI1.618–19.876; p = .007) and higher cardiovascular death (HR11.939; 95%CI1.439–99.031; p = .022) as compared with CrCl≥80 ml/min category. Nevertheless, for TE and major bleeding risk, CrCl groups showed no significant difference after adjustment for variables in CHA2DS2‐VASc score and status of warfarin prescription in our cohort. Conclusions In Chinese ED nonvalvular AF patients, incidence rates of death increased with reducing CrCl across the whole range of renal function. CrCl < 30 ml/min was associated with all‐cause death, cardiovascular death, but not for TE and major bleeding.
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Wang et al. (2022) conducted an observational in Nonvalvular atrial fibrillation (n=863). Creatinine clearance < 30 ml/min vs. Creatinine clearance ≥ 80 ml/min was evaluated on All-cause death (HR 5.567, 95% CI 1.618-19.876, p=0.007). In Chinese emergency department patients with nonvalvular atrial fibrillation, severe renal impairment was associated with a higher risk of all-cause death compared to normal renal function.
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